Aquatic Exercises Combined With Cognitive Tasks for Older Adults

Official title

Effects of Aquatic Aerobic Exercises Combined With Cognitive Tasks on Cognitive Function and Other Health-related Outcomes in Older Adults

Overview

The aquatic environment has characteristics that favor the adherence of older adults to exercise programs, and studies have shown that programs in this setting are effective in enhancing various aspects of physical fitness as well as cognitive function in this population. Research has explored whether incorporating cognitive tasks into an aquatic exercise program could offer additional benefits, but it remains uncertain whether this approach leads to greater improvements in cognitive function compared to aquatic exercises alone. The present protocol reports the WaterCog Study, which aims to evaluate the effects of an aquatic aerobic exercise program combined with cognitive tasks, compared to a conventional aquatic aerobic exercise program and a control group, on cognitive function and other health-related outcomes in older adults. This trial is a randomized, single-blinded, three-arm, parallel, superiority trial. A total of 98 older adults are randomized into one of three groups: 1) an aquatic aerobic exercise program combined with cognitive tasks, 2) a conventional aquatic aerobic exercise program, and 3) a control group. Participants in both exercise groups complete a 12-week exercise program with two weekly sessions on non-consecutive days. The primary outcome is cognitive function, while secondary outcomes include physical function, cardiovascular, and psychosocial parameters. Outcomes are measured at baseline, post-intervention, and at the 12-week follow-up after the end of the intervention period. The analysis plan will employ an intention-to-treat approach and per-protocol criteria. The conceptual hypothesis of the study is that both training programs will significantly improve the investigated outcomes compared to the control group. Additionally, it is expected that aquatic exercises with cognitive tasks will promote additional benefits in cognitive function, with similar gains in physical function, cardiovascular, and psychosocial parameters compared to conventional aquatic aerobic exercises in post-intervention and follow-up measures.

Interventions

• Other Aquatic aerobic exercise program
  The aquatic exercise sessions include the following exercises: butt kick, frontal kick, cross-country skiing, and stationary running. These exercises are commonly used in water aerobics classes and provide controlled osteoarticular impact, being safe for older women (Alberton et al., 2019). Training intensity is prescribed using Borg's 6-20 rating of perceived exertion (RPE) scale. The adopted strategy is based on interval training, which alternates between high-intensity effort and low-intensit
• Other Cognitive tasks
  This group performs the same aerobic training protocol used by the conventional aquatic program group. Additionally, cognitive tasks are performed during the active recovery phases. Cognitive training encompasses different domains of cognition in all sessions, including semantic fluency, processing speed, cognitive flexibility, inhibitory control, memory, attention, and reasoning. The exercises vary in each class, with progression in complexity in each mesocycle.

Primary outcome measures

• Objective cognitive function - Digit Span Test [Time frame: Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)]
• Objective cognitive function - Controlled Oral Word Association Test [Time frame: Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)]

Secondary outcome measures (12)

• Objective cognitive function - Trail Making Test (TMT) [Time frame: Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)]
• Self-perception of cognitive function [Time frame: Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)]
• Aerobic fitness [Time frame: Baseline (week 0) to post-training (week 13)]
• Lower limb strength [Time frame: Baseline (week 0) to post-training (week 13)]
• Upper limb strength [Time frame: Baseline (week 0) to post-training (week 13)]
• Lower limb flexibility [Time frame: Baseline (week 0) to post-training (week 13)]
• Agility and dynamic balance [Time frame: Baseline (week 0) to post-training (week 13)]
• Dual-task performance [Time frame: Baseline (week 0) to post-training (week 13)]
• Blood pressure [Time frame: Baseline (week 0) to post-training (week 13)]
• Blood pressure reactivity [Time frame: Baseline (week 0) to post-training (week 13)]
• Heart rate variability [Time frame: Baseline (week 0) to post-training (week 13)]
• Depressive and anxiety symptoms [Time frame: Baseline (week 0) to post-training (week 13)]

Eligibility criteria

Inclusion criteria

• Older women aged 60 and 75 years;
• Being physically inactive, meaning not participating in physical exercise for at least six months (regular exercise is defined as engaging in any physical training for a minimum of 20 minutes on two or more days a week).

Exclusion criteria

• History of cardiovascular disease (except controlled hypertension);
• Osteoarticular limitations for the practice of exercises;
• Being illiterate due to the self-completion questionnaires and the characteristics of the intervention;
• Diagnosis of dementia, schizophrenia, or major depressive disorder.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Brazil · 1 center

• Escola Superior de Educação Física e Fisioterapia — Pelotas

Publications

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• Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. [Suggestions for utilization of the mini-mental state examination in Brazil]. Arq Neuropsiquiatr. 2003 Sep;61(3B):777-81. doi: 10.1590/s0004-282x2003000500014. Epub 2003 Oct 28. Portuguese. PMID 14595482
• Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. [Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref]. Rev Saude Publica. 2000 Apr;34(2):178-83. doi: 10.1590/s0034-89102000000200012. Portuguese. PMID 10881154
• Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME, Barreto SS. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011 Jan;12(1):70-5. doi: 10.1016/j.sleep.2010.04.020. Epub 2010 Dec 9. PMID 21145786
• Botega NJ, Bio MR, Zomignani MA, Garcia C Jr, Pereira WA. [Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD]. Rev Saude Publica. 1995 Oct;29(5):355-63. doi: 10.1590/s0034-89101995000500004. Portuguese. PMID 8731275
• Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996 Mar;17(3):354-81. No abstract available. PMID 8737210
• STROOP, J. R. Studies of interference in serial verbal reactions. Journal of Experimental Psychology, v. 18, n. 6, p. 643-662, 1935.

Identifiers

NCT: NCT07156708 · 90526525.0.0000.5313

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗